Bang Thu~t Ngfr v~ Bao Hi~m Swc Kh6e va Tw Ngfr Y Khoa Bang thu~t ngft nay d1h ngh1a nhi~u tu ngtl tlurctng duqc su d\mg, nJnmg kh6ng pl}ai la mot danh sach dfty d1i.

Cac tir ngi.l va cac dinh nglna trnng bang tlm~t Qgfr nay c6 y dih giao d\lC va c_6 the khac v&i cac n'r ngfr v~ di.uh ngh1a trong chuong t:rinh hay chinh sa.ch bao h.iem s(rc khoe Clia guy vi. fy!Qt so cac n'r ngfi' nay cfing c6 the kh6ng c6 nghr~ chinh xac gi6ng nhau khi duqc su d\m~ trong chinh sach bao hien~ hay trong chuong trinh c1ia guy yi, va trong bat Cl? tnrang hqp 1180, chinh sach bao hiem, hay chUO'llg trinh cfu~g deu I~am guyen chi ph6i. (Xem pl1.an T6m Luqc ve Quyen LQ'i va Dai Th9 c1ia Bao H.iem de biet thong tin ve each lay ban sao cbinh sach bao hiem hay tai li~u clmO'llg trinh c1ia q!tY vi.)

Tir ngtl duac gach du&i bieu hi~n mQt tir ngft duqc djnh nghra tro~1g bai,ig Thu~l. NglJ nay. . Xem tr~ng 6 de c6 mot vi d t:rinh bay each nhf'mg gi&i h~n clia tien khan trir, tien dong bao hiem va cac gi&i h~n

tu tra ket hqp vO'i nhau ra sao trong hoan canh c11a cu9c song dcti th\rc.

Allowed Amont (S6 Ti~n Cho Phep Chi Tra) Compli~ations of Pre2nancy Day la chi tra toi da ma chuCYDg trinh se tra ct10 mot (tich V\l (Cac Bien Ch1m2 ctia Thai Ky) cham soc sfrc khoe du

Deductibles (Ti~n Khiu Trir) M(}t s& li~n quy vi c;o the con tbieu trong mot gi~i do~n bao biem (tlurcrng la mQt narn) cho cac cijch V\l cham soc Jane tra 100% Chuang trinh s(rc khoe d.uqc ctia co tra 0% dai th tnr&c khi (xem b:~ 6 d@ co m(>t vi di) chi ti~) chuang trinh cua _ , _ . quy vi bat ~au tra. MQt so _tie'). khau tn:r _tong quat duqc ap di,mg cho tat ca hay hau bet tat ca cac do v~t nr va _dich V\l duoc dai tho. Mot chuang t:Iinh v&i mot khoan khau trir t61ig quat cring co the co cac khoan khu trir tjeng bi~t ap d1,111g cho cac dich V\l hay nhom dich V\l C\l th~. Mot chuang trinh cfmg_co th~ chi co cac khoan khan tnr 1ieng bi~t. (Vi d\l, neu tien kbau tru Clla quy Vi la,$1000. cquang trinh cua quy vi se kh9ng t:1:a cho bat ctr cai gi cho den khi quy Vi d.a lra $1000 tien kbau lllf Clia quy vi cho cas cijch V\l cham soc strc lchoe duqc dai tho theo khoan khau trir nay).

Diagnostic Test (~et Nghi~~ c~in B~nh) Cac xet ngbi~m de coi XeJ.!l van d~ SlJC khoe Clla quy vi la gi . .Vi d\l, chp quang rnyen co the la lllQt xet nghiem chan berm de xem coi quy vi co bi gay xuong hay khong.

Dur~ble Medi_cal Equipment (QME) (Th!et Bi Y 'f e Sfr D\mg Lau Ben, D_ME) Tlliet bi va do v~t tu duqc nha cung ca2 dich vu char soc SllC kboe ke toa d~t hang _de sir d;\lllg mqi ngay hay d.e SU d1,1.ng lau dai. DME c6 the bao gom: thiet bi th.a ducrng khi, xe Ian, va n~g.

Emergency Medi.cal Condition (Btnh Tr~ng Cip C(m) M(}t can benh, chan tlurO'ng, tri~u chtTJ!g (ke ca con dau du doi), hay tinh tr~ng_ du lam nguy hiem nghiem trong t~ SllC kbo~ Clla quy Vi neu quy vi khon_g dUQC cham SOC y te ngay. Ne\l kh~ng d.m;rc cham soc y t~ ngay, mQt trong nhwg dieu bien nhien sau day co tl1e xay ra cho quy vi: I) Strc k,hoe cua quy vi se bi lam vao tili t,r~ng qrc ky nguy hiem; hay 2) quy Vi Se g~p cac V~l de nghiem trng v&i cac chfrc nang ho~t d9ng cua ca ~e quy vi; ho~c 3) Quy vi se bi lnr h~i 11:a,m t:19ng cho bat ctr bo pMn hay ca quan nao trong co the cua quy vi.

Emergency Medical TransportaJioJ! (PhUO'llg Ti~n V~n Chuy~n Y Te Cap CU'u) Cac dicJ1 vi.1 xe ctm thuong cho mot benh t:Iang trong tinh tqmg cap Cllll: Cac hiph thtrc phuO'ng ti~n v~ chuyen y ~e C~p Cllll CO the bao gom phuang tien hang khong, tre.n

Hospitalization (Nim Vi~n) Viec cham SOC t~i b~nh vien doi hoi dU9'C llll~p vi~n n1nr lllQt b~nh ruian 11Qi tru va thuang yen can phai O l~i qua _ dem. MQt so chuong trinh c6 the coi vi~c a l~i qua dem de quan sat nhu cham soc ngo~i tr(1 thay vi c.ham soc noi tru.

Hospital Outpatient Care (Cham Soc N2o~i Tru T,i Bfnh Vifn) , viec cham soc trong benh vi~n thucrng khong yen cau phai o l~i qua dem. Indhidal Responsibility Requirement (Yeu Cau Trach Nhi~m Ca Nhan) Doi khi _duqc g9i la "W uy nhi~m ca nhan", nghla Vl,l quy vt co the pp.ai g!1i da1V-1 \'.ao cqmmg trinh bao hiem cung cap bao hiem can thiet toi thieu. Neu, quy vi kho_ng c6 bao hiem can thiet toi thieu, quy vi c6 the phai ~a tien ph~t khi khai Jlme lien bang_ tn'r phi quy vi d11 dieu kien hqp 1~ duqc mien mua bao hiem strc khoe.

In-network Coinsurance (Tifn D6ng Bao Hi~m Trong M~ng LU'oi) , Phan chia se cua quy vi (vi d\l, 20%) c1'la so tien duac phep chi tra cho cac dich V\l cham soc ~(re khoe duqc dai th9. Phan chia se cu.a quy vi tlurang thap ban v&i cac dich V\l duqc dai th9 trong mang hr&i.

In-1_1etw~rk Copayment (Tien po~g l)a Trong M~ng Lum) MQt so tien co di1ili (vi d\l, $15) guy vi tni cho ca.c dich V\l cham soc s(rc khqe duqc dai thQ cho cac nha cung cap dich vu c6 hqp dong v&i bao hiem sue khoe hay v&i chuang trin11 c11a quy vi. N)1f:qig s{) tien dong tra trong m~ng hr&i thucrng it ban so tien dong tra ngoai mang hrm.

Marketplace _ MQt thi tnrang cho bao hiem sue khoe l}O'i cac c;a n1_1an, gia dinh va cac doanh nghi~p nho c6 the tim hieu ve cac hra ch9n cho chuang trinh cua h9; so san11 giua ca

Out-of-network Coinsurance (Tifn Dilng Bao Hi~m Ngoai ~~l!g LU'oi) Phan chia se (vi d\1, 40%) cho so tien ductc phep chi tra. cl'ta quy vi cho cac die~ V1;t cham soc s(rc khoe dqqc dai thQ tai. cac nha cung cap dich vu khong co hQ'P dong va_i bao hiem sue khoe hay vai chuctng tdnh i;11a quy vi. Tien dong ~ao hiem,ngo~i m~g lu.ai tlnrang ton kem cho quy vi nhieu hctn tien dong bao hiem trong mang hrai.

Out-of-r:i-etwork Copayment (Tien ,>og 1ra Ngoai Mi,ng LU'oi) MQt so tien co din}1 (vi d1,1, $30) quy vi tra cho cac ,dich V1;t cham soc s(rc khoe_duqc dai thQ q.r cac 11ha cung cap dich .Y!! khong co hqp dong vai bao hiem sue khoe hay vai chuctng trinh cu~ quy vi._ C3:c so_ tien dong tra ngoai m~ng lu&i tlnrang nhieu hctn so tien dong tra trong mang hrai.

Out-of-network Provider (Nha Cung Cap Djch VI} Ngoai l\~i,ng Ltroi) (Non-Preferred Pro"ider, Nha Cung Cap Djc~ VI} Khong Uu Tien) , MQt nha Cllllg cap dich vu ,khong co hQP, dong vai chuctng trinh clia quy vi de cung cap dich V\l. Neu chuctng tiinh cua quy vi dai thQ ct10 cac di~h V\l ngoai m~g luai; quy vi tlnrcmg se tra nhieu hctn de kham v&i nh~ cung cap dich V\l ngoai m~g hr&i hctl! la mQt nha cung cap dich vu uu tien. Chinh ~ach bao J}iem c11a quy vi se gi~i thich cac phi ton do co the la phi ton gi. Cung con co the duqc gQi la ")~hong m1 tien" hay "khong tham gia" thay vi "nha cung cap dich V\l ngoai m~ng hrai".

Out-of-pocket Limit (Gioi Hi,n T1.r Tra) Khoang thai. gian quy_ vi co, the tra 11ltjeu nhat trong snot mot thai doanctiabao ltiim (tlurang la m9tnam) cho kJ1oan cltia se ph:f ton Clla quy Vi Ve cac dich vu ductc

Jane Ira 0% Chuong trlnh cua co tra 100%

(xem trang 6 d~ c6 m(>t vi di) chi ti~)

dai thQ. Sa11 kill quy vi dap (mg dUQ'C gicri h:;in nay, chuct11g tiinh tlurang se tra 100% so tien ductc phep chi tia. Gi&i h~ nay giup quy vi ho:;ich dinh cho cac chi pl_1i cl!am soc sfrc k11oe. Giai h~ nay khong bao gia bao gom tien dong bao phi, phi can doi hoa dctn Clla quy vi hay Vi~c cham s6c sfrc kl1oe ma clurctng trinh qia quy vi khong dai thQ. MQt so chuctng tiinh ~hong_ tinh tat ~a c~c chi tra c\10 cac k11oan tien dong tra, tien khau tJ.ir, tien dong bao hiem cua quy vi, cac chi tra ngoai m:;ing hr&i, hay cac ch.i phi k11ac cho g.i&i h:;in nay.

Physician Services (Cac Djch V\1 cna Bae Si), . Cac dich V1;t cham s6c s(rc khoe, m9t y sr co giay phep, ke ca m9t M.D. (bac si y k110a). (Bae Si Y Khoa) hay D.O. (Bae Si Khoa Xuctng) Doctor 9f Osteov.atltic_Medicine (Bae Si Khoa Xtrctng), cung cap hay dieu phoi.

Bang Thu~t Ngft ve Bao Hiem SU'c Khoe va Tlt Ngft Y Khoa

Plan (~htrO'llg Trinh) , , B~o hiem s(rc kl1oe duqc cap cho quy vi tnJc tiep (bao hiem ca_nhan) hay thong qua du) hang,_ cong doan hay nhom ho trq k11a.C ( clnrctng tritlh bao .hiem theo 1111\:>In Cll~ clu't hang) ma hQ c6 cung cap bao hiem cho m9t so phi ton cham s,oc sfrc khoe. Cung con duqc gi ta "chmmg trhll1 bao lti~m sue khoe". "chill11 sad~ bao hiem", "chinh sach bao ltiem s(rc khoe" hay "bao hiem s(rc khoe".

Preauth~rization (Phe Chuan Tl:U'uc) M9t quyet d1h boi cong ty b~o hiem sfrc khoe hay bed chuct11g trit1h cl'ta quy yi cho ran_g mQt dich V1;t c~am s6c, SllC khoe, ke l!O:;!Ch dieu tl'i, thuoc CO toa hay thiet bi V te Sl'r dung lau ben (durable medical equipment. DME) la can thiet ve mat V te. Doi khi con gQi la S\l phe ch~n tnr&c, chap tl11$1 t11r&c hay xac 11h~n tllJ&c. Bao hiem sfrc khoe hay clurctng tlinh Clla quy Vi CO the yeu cau Si;! chap tlm~n tnrac cho mQt so dich Vl;t tru&c kl: quy vi nh~n dU\ff, ngo~i tlir trong Ill Qt tnrang hqp cap ctm. SIJ phe chuan tnr&c khong phai la mQt loo h(ra ma bao hiem sue khoe hay chtrctng trinh Clla quy vi Se dai thQ cho phi ton do.

Premium (Bao Phi) s6 ti~n phai duqc lra cho bao hi~m s(rc khoe hay chuctng trinh Clia quy vi. Quy vi va/hay chll hang Cl'la quy vi tlnrang tra cho so tien bao phi theo hang thang, hang quy, hay hang nam.

Premium Tax Credits (Tin qli T~ue D~ Dong Bao P~i) S1,1' giup dcr tai charu1 de h~ thap tieq thue c11a. quy vi de gi(1p quy vi va gia dit~l quy vi tra tien bao hiem sue khoe tU Illian. Quy Vi CO the CO dtrqc S\l gi(1p dct nay neu quy Vi co bao hiem sue khoe qu~1 Marketplace va thu nh~p cl'ta quy vi ~uai mt nnrc 11.l1at dl11. Cac .chi tra,tnr&c cbo tin chi thue c6 the duqc su d\mg ngay de h~ thap phi ton dong bao phi hang thang Clla quy vi. Prescription Drug Coverage (Dai Th9 Cho Thu6c Co Toa) . , S\t gai thQ duai _mQt clurctng trinh de gifrp Ira. cho tien cho thuoc c6 toa. Neu daru1 sach thuoc cfta clnrctng tri1ili dimg "cac cap dQ" (muc dQ), sac lo:;ii thUQC CO toa dUQ'C cl,iia . thrulh nhom b&i lo~i thuo